Overview
Spinal cord injury (SCI) is caused by trauma or damage to the spinal cord. It can result in either a
temporary or permanent alteration in the function of the spinal cord. About 12,000 Americans suffer
SCIs each year. The number of people living with SCI is about 260,000. With improved treatment
strategies, even the very young patient with an SCI can anticipate a long life. Frequent causes of SCI
include motor vehicle collisions, falls, violence, and sports injuries. SCIs are classified by the
mechanism of injury, level of injury, and degree of injury. Mechanisms of injury include flexion,
hyperextension, flexion-rotation, extension-rotation, and compression. Levels of injury may be
cervical, thoracic, lumbar, or sacral. The degree of injury may be complete or incomplete. Complete
cord damage results in total motor and sensory loss below the level of the injury, while incomplete
cord damage results in a mixed loss of motor activity and sensation, with some tracts left intact.
Tearing and transection of the cord may occur as a result of penetrating injury, such as gunshot and
stab wounds, but most complete cord damage occurs as a result of secondary damage in response to
the injury.
The extent of the neurologic damage caused by a spinal cord injury results from primary injury
damage (actual physical disruption of axons) and secondary injury damage (ischemia, hypoxia,
hemorrhage, and edema). Because secondary injury progresses over time, the extent of the injury and
prognosis for recovery are most accurately determined at least 72 hours or more after injury.
Objectives
Differentiate spinal shock and neurogenic shock.
Identify relevant assessment data for a patient with a spinal cord injury (SCI).
Discuss the pathophysiology related to an SCI.
Prioritize nursing care of a patient with an acute SCI.
Appropriately delegate nursing care of a patient with an acute SCI.
Describe the collaborative management of a patient with an SCI.
Develop an individualized nursing care plan for a patient with an SCI.
Discuss the prognosis for rehabilitation for a patient with an SCI.
Case Study
C.R. is a 42-year-old white male who fell from a 60-foot scaffold while working on the construction of
a new building. He is admitted to the emergency department (ED) by ambulance and is strapped to a
rigid backboard with cervical immobilization. At the site of the accident, J.D.'s co-workers
immobilized his body until the ambulance arrived. His supervisor called his wife.
C.R.'s wife arrives at the emergency room at the same time the ambulance arrives. She is very agitated
and crying. He sees her as he is wheeled into the ED and reassures her that he is okay and tells her he
fell at work. You take her to a waiting room, explaining that she can see her husband as soon as he is
stabilized.
Initial physical findings include a flaccid paralysis and loss of sensation of the lower extremities and
trunk. He has sensation and movement of the arms and hands with decreased grasp strength. His
extremities are warm and dry. Vital signs are blood pressure (BP) 88/50, pulse 35 beats/minute,
respirations 26 breaths/minute and shallow, and temperature 97° F (36.1° C). His clothing is torn in
several places, revealing a large abrasion on his right shoulder, a bruised right upper arm, and a deeply
abraded right upper leg. He complains of burning pain in his right upper arm and shoulder. He had
bowel and bladder incontinence at the site of the accident but does not seem aware of it. He has a
peripheral IV of normal saline at 75 mL/hr started by the paramedics.
, 1. C.R.'s airway is not compromised, and he remains immobilized on the backboard. To plan care for
C.R., you anticipate the emergency management that is indicated. Select the interventions that might
be indicated in the emergency management of C.R.
A. Administration of atropine
- For low heart rate
B. Administration of morphine
- For pain
C. Endotracheal intubation
- Precautionary, because patient has spinal injury and could cause further swelling, threatening
the airway.
D. Administration of vasopressors such as dopamine (Intropin)
- dobutamine is more specific for HR, dopamine for BP
E. Insertion of a nasogastric tube to suction – to check for gastric
bleeding and for enteral feeding since it is preferred for GI
wellness over TPN. If not tolerated, TPN givne.
F. Insertion of an indwelling catheter
- pt was incontinent
G. Application of a cooling blanket
H. Initiation of a second IV site with a large-bore catheter
I. Administration of oxygen
J. Cardiac monitoring - always
2. C.R.'s initial presentation indicates that he is in spinal shock. An additional finding that indicates
spinal shock is
1. inability to cough.
2. reflex emptying of the bladder.
3. hyperreflexia below the level of the injury.
4. decreased reflexes below the level of the injury.
Rationale: About 50% of people with acute spinal cord injury experience a temporary neurologic
syndrome known as spinal shock. This type of shock is characterized by decreased reflexes, loss of
sensation, and flaccid paralysis below the level of the injury. This syndrome lasts days to months and
may mask post injury neurologic function.
3. You determine that C.R. is in neurogenic shock in addition to spinal shock. The three findings in his
initial assessment that indicate neurogenic shock and the patient is experiencing Cushing’s Triad:
choose the symptoms this patient is likely exhibiting: Select all that Apply
A. Bradycardia
B. Hypertension
C. Fever
D. Widening pulse pressure
E. Irregular respirations- bradypnea
Spinal cord injury (SCI) is caused by trauma or damage to the spinal cord. It can result in either a
temporary or permanent alteration in the function of the spinal cord. About 12,000 Americans suffer
SCIs each year. The number of people living with SCI is about 260,000. With improved treatment
strategies, even the very young patient with an SCI can anticipate a long life. Frequent causes of SCI
include motor vehicle collisions, falls, violence, and sports injuries. SCIs are classified by the
mechanism of injury, level of injury, and degree of injury. Mechanisms of injury include flexion,
hyperextension, flexion-rotation, extension-rotation, and compression. Levels of injury may be
cervical, thoracic, lumbar, or sacral. The degree of injury may be complete or incomplete. Complete
cord damage results in total motor and sensory loss below the level of the injury, while incomplete
cord damage results in a mixed loss of motor activity and sensation, with some tracts left intact.
Tearing and transection of the cord may occur as a result of penetrating injury, such as gunshot and
stab wounds, but most complete cord damage occurs as a result of secondary damage in response to
the injury.
The extent of the neurologic damage caused by a spinal cord injury results from primary injury
damage (actual physical disruption of axons) and secondary injury damage (ischemia, hypoxia,
hemorrhage, and edema). Because secondary injury progresses over time, the extent of the injury and
prognosis for recovery are most accurately determined at least 72 hours or more after injury.
Objectives
Differentiate spinal shock and neurogenic shock.
Identify relevant assessment data for a patient with a spinal cord injury (SCI).
Discuss the pathophysiology related to an SCI.
Prioritize nursing care of a patient with an acute SCI.
Appropriately delegate nursing care of a patient with an acute SCI.
Describe the collaborative management of a patient with an SCI.
Develop an individualized nursing care plan for a patient with an SCI.
Discuss the prognosis for rehabilitation for a patient with an SCI.
Case Study
C.R. is a 42-year-old white male who fell from a 60-foot scaffold while working on the construction of
a new building. He is admitted to the emergency department (ED) by ambulance and is strapped to a
rigid backboard with cervical immobilization. At the site of the accident, J.D.'s co-workers
immobilized his body until the ambulance arrived. His supervisor called his wife.
C.R.'s wife arrives at the emergency room at the same time the ambulance arrives. She is very agitated
and crying. He sees her as he is wheeled into the ED and reassures her that he is okay and tells her he
fell at work. You take her to a waiting room, explaining that she can see her husband as soon as he is
stabilized.
Initial physical findings include a flaccid paralysis and loss of sensation of the lower extremities and
trunk. He has sensation and movement of the arms and hands with decreased grasp strength. His
extremities are warm and dry. Vital signs are blood pressure (BP) 88/50, pulse 35 beats/minute,
respirations 26 breaths/minute and shallow, and temperature 97° F (36.1° C). His clothing is torn in
several places, revealing a large abrasion on his right shoulder, a bruised right upper arm, and a deeply
abraded right upper leg. He complains of burning pain in his right upper arm and shoulder. He had
bowel and bladder incontinence at the site of the accident but does not seem aware of it. He has a
peripheral IV of normal saline at 75 mL/hr started by the paramedics.
, 1. C.R.'s airway is not compromised, and he remains immobilized on the backboard. To plan care for
C.R., you anticipate the emergency management that is indicated. Select the interventions that might
be indicated in the emergency management of C.R.
A. Administration of atropine
- For low heart rate
B. Administration of morphine
- For pain
C. Endotracheal intubation
- Precautionary, because patient has spinal injury and could cause further swelling, threatening
the airway.
D. Administration of vasopressors such as dopamine (Intropin)
- dobutamine is more specific for HR, dopamine for BP
E. Insertion of a nasogastric tube to suction – to check for gastric
bleeding and for enteral feeding since it is preferred for GI
wellness over TPN. If not tolerated, TPN givne.
F. Insertion of an indwelling catheter
- pt was incontinent
G. Application of a cooling blanket
H. Initiation of a second IV site with a large-bore catheter
I. Administration of oxygen
J. Cardiac monitoring - always
2. C.R.'s initial presentation indicates that he is in spinal shock. An additional finding that indicates
spinal shock is
1. inability to cough.
2. reflex emptying of the bladder.
3. hyperreflexia below the level of the injury.
4. decreased reflexes below the level of the injury.
Rationale: About 50% of people with acute spinal cord injury experience a temporary neurologic
syndrome known as spinal shock. This type of shock is characterized by decreased reflexes, loss of
sensation, and flaccid paralysis below the level of the injury. This syndrome lasts days to months and
may mask post injury neurologic function.
3. You determine that C.R. is in neurogenic shock in addition to spinal shock. The three findings in his
initial assessment that indicate neurogenic shock and the patient is experiencing Cushing’s Triad:
choose the symptoms this patient is likely exhibiting: Select all that Apply
A. Bradycardia
B. Hypertension
C. Fever
D. Widening pulse pressure
E. Irregular respirations- bradypnea
